INTERACTION BETWEEN NATIVITY AND NEIGHBORHOOD ON DEMENTIA RISK: FINDINGS FROM TEN YEARS OF NATIONAL US DATA

Abstract Prior research indicates neighborhood disadvantage increases dementia risk. There is, however, inconclusive evidence on the relationship between nativity and cognitive impairment. To our knowledge, our study is the first to analyze how nativity and neighborhood interact to influence dementia risk. Ten years of prospective cohort data (2011-2020) were retrieved from the National Health and Aging Trends Study, a nationally representative sample of 5,362 U.S. older adults aged 65+. Cox regression analyzed time to dementia diagnosis using nativity status (foreign or native-born) and composite scores for neighborhood physical disorder (litter, graffiti, vacancies) and social cohesion (know, help, trust each other), after applying sampling weights and imputing missing data. Average baseline neighborhood physical disorder was significantly higher among foreign-born (0.28) compared to native-born (0.18) older adults [t=-2.4, p=.02]. Average baseline neighborhood social cohesion was significantly lower for foreign-born (3.57) compared to native-born (4.33) older adults [t=5.5, p<.001]. After adjusting for sociodemographic, health, and neighborhood variables, foreign-born older adults had a 51% significantly higher dementia risk (aHR=1.51, 95% CI=1.19-1.90, p<.01). There were no statistically significant interactions for nativity with neighborhood physical disorder or social cohesion. Our findings suggest foreign-born older adults have higher neighborhood physical disorder and lower social cohesion compared to native-born older adults. Despite the higher dementia risk we observed for foreign-born older adults, this relationship was not moderated by either neighborhood physical disorder or social cohesion. Further research is needed to understand what factors are contributing to elevated dementia risk among foreign-born older adults.

caregivers or no local ADNA, and limited local leadership support were other factors noted that could limit expansion.Importantly, Veterans were often overwhelmed by the employer responsibilities they needed to fulfill.Addressing these concerns remains a challenge to VISN 8 and national leadership.

ALZHEIMER'S DISEASE AND RELATED DEMENTIAS (SRPP) I
Abstract citation ID: igad104.0012Hospital-to-skilled nursing facility (SNF) transitions are fraught with coordination challenges, motivating selective investments by hospitals to improve transitional care practices with "preferred" (e.g.high-volume) SNF partners.Because these partners have some agency in which patients they admit, it is unclear whether Medicare beneficiaries with social or clinical complexities, such as individuals with Alzheimer's disease and related dementias (ADRD) have equitable access to these preferred SNFs.To answer this question, we use a linear probability choice model to test the differential effect of a SNF's "preferredness" on patient placement for ADRD vs non-ADRD beneficiaries.We use a 1:1 matched sample of ADRD and non-ADRD fee-for-service beneficiaries (N=76,762) to account for other primary factors affecting placement (i.e.discharging hospital, beneficiaries' home address).After controlling for SNF characteristics, the estimated effect of a SNF being "preferred" on likelihood of placement was 12.7% lower for patients with ADRD (0.092 vs 0.103 for non-ADRD; p< 0.001).Simulation results suggest that, as a preferred SNF is assumed to have an increasing percentage of a hospital's discharges, the likelihood of a patient being discharged there grows much faster for non-ADRD patients compared to those with ADRD.Our findings show that ADRD patients may have unequal access to SNFs that are receiving the most investments from hospitals in the form of transitional care improvements.Policymakers should consider systemic investments that benefit all SNF partners, not just the most preferred based on shared discharges, while also weighing the costs of dispersing these investments too broadly.

ACCESS TO PREFERRED POSTACUTE CARE PATHWAYS FOR PATIENTS WITH ALZHEIMER'S DISEASE AND RELATED DEMENTIAS
Abstract citation ID: igad104.0013

INTERACTION BETWEEN NATIVITY AND NEIGHBORHOOD ON DEMENTIA RISK: FINDINGS FROM TEN YEARS OF NATIONAL US DATA Roger Wong, and Daniel Soong, SUNY Upstate Medical University, Syracuse, New York, United States
Prior research indicates neighborhood disadvantage increases dementia risk.There is, however, inconclusive evidence on the relationship between nativity and cognitive impairment.To our knowledge, our study is the first to analyze how nativity and neighborhood interact to influence dementia risk.Ten years of prospective cohort data (2011-2020) were retrieved from the National Health and Aging Trends Study, a nationally representative sample of 5,362 U.S. older adults aged 65+.Cox regression analyzed time to dementia diagnosis using nativity status (foreign or native-born) and composite scores for neighborhood physical disorder (litter, graffiti, vacancies) and social cohesion (know, help, trust each other), after applying sampling weights and imputing missing data.Average baseline neighborhood physical disorder was significantly higher among foreign-born (0.28) compared to native-born (0.18) older adults [t=-2.4,p=.02].Average baseline neighborhood social cohesion was significantly lower for foreign-born (3.57) compared to nativeborn (4.33) older adults [t=5.5, p<.001].After adjusting for sociodemographic, health, and neighborhood variables, foreign-born older adults had a 51% significantly higher dementia risk (aHR=1.51,95% CI=1.19-1.90, p<.01).There were no statistically significant interactions for nativity with neighborhood physical disorder or social cohesion.Our findings suggest foreign-born older adults have higher neighborhood physical disorder and lower social cohesion compared to native-born older adults.Despite the higher dementia risk we observed for foreign-born older adults, this relationship was not moderated by either neighborhood physical disorder or social cohesion.Further research is needed to understand what factors are contributing to elevated dementia risk among foreign-born older adults.
Abstract citation ID: igad104.0014By 2060, the prevalence of Alzheimer's disease and related dementias (ADRD) in the U.S. is predicted to more than double to 14 million.African Americans (A.A.) 65 and older are 2.5 times more likely to develop Alzheimer's than same-aged White Americans.Furthermore, A.A. are twice as likely to be underdiagnosed, leaving the A.A. community underserved with respect to ADRD.To gain insight into the key drivers of this underdiagnosis, we performed a scoping review of research on attitudes and perceptions held within the A.A. community regarding ADRD, which may impact diagnosis and screening.We searched PubMed, CINAHL, Web of Science, and Black Studies Periodicals Database for studies from 2002 to 2022 using keywords: "Dementia" or "Alzheimer's" and "African Americans," "Ethnicity," "Racial Groups," "Blacks," or "Ethnic and Racial Minorities," and "Health Knowledge, Attitudes, Practice," "Health Services Needs and Demand," or "Perception."We identified 318 studies; 49 met inclusion criteria after title and abstract review and were selected for full manuscript review.We discussed all included manuscripts and identified pertinent themes, noting potential method bias.An identified "knowledge gap" among A.A. about dementia, particularly a belief that dementia is part of normal aging or God's will, was prominent.Other themes included mistrust of the medical community, a desire to maintain everyday family life, the need for culturally appropriate resources, and cultural expectations to provide care despite institutional support obstacles (John Henryism/Superwoman schema).Understanding differences in attitudes and beliefs toward dementia among African Americans may support developing effective strategies to address disparities.People with Alzheimer's and related dementias require increasing assistance with basic life activities, yet one in three lives alone (i.e., is aging solo).Drawing on a strengthsbased perspective, this study seeks to identify barriers and facilitators to successful aging among adults who are aging solo with cognitive impairment or early dementia.We conducted semi-structured interviews with 15 adults aging solo with a diagnosis of cognitive impairment or early dementia (age 48-81, mean 69; 80% female; 86% white; 13% black; 7% Hispanic) and used a hybrid inductive/deductive thematic analysis approach to analyze the data.Participants identified self-advocacy, friendship networks, financial resources, and institutions (e.g., assisted living) as potential assets that could address future care needs.Participants described an identity as self-sufficient, fear of being a burden, and worries about exploitation as barriers to help-seeking.Facilitators to care-seeking from friends, neighbors, and others included a belief that helping is rewarding for others, being able to provide reciprocal favors, and framing careseeking as self-advocacy.Conclusion: Adults aging solo with early dementia face a number of challenges but also exhibit numerous strengths and can use a diversity of skills, attitudes, relationships, and tangible resources to address increasing care needs.

NEIGHBORHOODS AS A SPACE AND PLACE FOR HEALTHY AGING: NOVEL APPROACHES AND A VIEW OF THE FUTURE
Chair: Andrea Rosso Co-Chair: Michelle Carlson Discussant: Yvonne Michael The importance of neighborhood environments for health outcomes has gained increasing recognition in the past two decades.Both space (physical environment) and place (social environment) have implications for health behaviors and risk for acute events and chronic diseases.This symposium brings Taylor Bucy 1 , John McHugh 2 , and Dori Cross 1 , 1. University of Minnesota School of Public Health, Minneapolis, Minnesota, United States, 2. Mailman School of Public Health, Columbia University, New York City, New York, United States